Transcription

2 Questions To Address Who are candidates for insulin? When do we start insulin? How do the different types of insulin compare? How do we decide which type to use? How do we initiate and titrate insulin? What prevents us from starting insulin sooner?

3 Candidates for Insulin All Type 1 s Gestational Diabetes Type 2 s: Unable to control BG with orals/diet/exercise Newly diagnosed and in poor control Oral meds and/or incretin-based therapy not an option due to contraindications (comorbid conditions

17 QUESTION Which would be the an appropriate candidate for a regimen of 70/30 insulin am and pm? A. A 19 year old with T1DM B. A 29 year old executive newly diagnosed with T2DM C. A 70 year old retired teacher with T2DM D. All would be appropriate candidates

18 The Most Appropriate Candidate? A 19 year old with T1DM A 29 year old executive newly diagnosed with T2DM A 70 year old retired teacher with T2DM All would be appropriate candidates

24 Perception: Insulin Causes Blindness, CV Disease, and Other Diabetic Complications Some cultures believe that insulin is the beginning of the end or that it is actually toxic Meece, J., Dispelling Myths and Removing Barriers About Insulin in Type 2 Diabetes The Diabetes Educator January/February : 9S-18S

25 Perception: Hypoglycemia is to be Avoided at All Costs Older insulin products are associated with more hypoglycemia Explain that tight control may increase the likelihood of hypoglycemia Fear of hypoglycemia may be just as much of a barrier to good control as actual hypoglycemia Meece, J., Dispelling Myths and Removing Barriers About Insulin in Type 2 Diabetes The Diabetes Educator January/February : 9S-18S

34 Patient Empowerment As a clinician, how do you perceive insulin and the patient who needs it? What are your biggest concerns about starting insulin? What do you think about insulin? (Then Listen) Meece, J., Dispelling Myths and Removing Barriers About Insulin in Type 2 Diabetes The Diabetes Educator January/February : 9S-18S

35 How Do We Adjust Insulin for High Blood Glucoses and for Meals? Correction Factor (Sensitivity Factor) And Insulin to Carbohydrate Ratio

37 Correcting for High BG: Sensitivity Factor and the 1800 Rule Based on all units of insulin taken in a day To be applied to patients on rapid acting insulin Divide TDD of insulin into 1800 to find out how much 1 unit will decrease blood glucose. - Example: Patient is on 60 units a day of glargine - lispro: 10u for bkfast, 6u lunch, 12u dinner ISF = 1:20 accessed 5/1/2011

38 Insulin to Carb Ratio and the 500 Rule Grams of carbohydrate that are approximately covered by 1 unit of insulin. Most accurate for: - Those who make no insulin of their own - Receive 50-60% as basal insulin - On rapid-acting insulin Based on TDD of insulin for a person with type 1 diabetes in reasonable glycemic control - Example: patient is on 20 units a day of lispro and 30 units of glargine I:C ratio = 1:10

39 Insulin Challenge: SD takes an average of 24 units per day of insulin aspart with meals along with 30 units of insulin glargine at 10 PM each night. He is setting down to a meal of a baked potato, ham sandwich, salad and a small piece of chocolate cake. Total carbohydrate content: 90 gms His SMBG check shows: 220 mg/dl How many units should he inject before his meal?

Insulins CLASS OBJECTIVES Describe the history of insulin discovery List types of insulin Define indications and dosages Review case studies INVENTION OF INSULIN 1921 The first stills used to make insulin

Insulin Therapy In Type 2 DM Michael Fischer, M.D., M.S. Sources of support NaRCAD is supported by a grant from the Agency for Healthcare Research and Quality My current research projects are funded by

The basal plus strategy Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE ADA/EASD guidelines recommend use of basal insulin as early as the second step

Diabetes and Insulin Pumps Amy S. Pullen Pharm.D ISHP Spring Meeting April 2012 Objectives Describe the different types of insulin used in diabetes Identify the types of insulin that are compatible with

Insulin/Diabetes Calculations Dr. Aipoalani St Lukes Endocrinology Goals Describe various calculations for insulin dosing Understand importance of the total daily dose (TDD) of insulin Be able to calculate

Insulin onset, peak and duration of action Insulin was first discovered in the early 190 s. Before then, diabetes could not be treated. Insulin was then taken from cow and pig pancreases, but nearly all

T y p e 1 T y p e 2 INSULINThere are many different insulins for Characteristics The three characteristics of insulin are: Onset. The length of time before insulin reaches the bloodstream and begins lowering

Insulin Action There are several types of insulin. They are classified by how long they act: very fast, fast, slow and very slow acting. Each type of insulin has a certain time period in which it works.

KENTUCKY DIABETES NETWORK, INC. Algorithms for Glycemic Management of Type 2 Diabetes The Diabetes Care Algorithms for Type 2 Diabetes included within this document are taken from the American Association

Present and Future of Insulin Therapy: Research Rationale for New Insulins Current insulin analogues represent an important advance over human insulins, but clinically important limitations of these agents

Intensifying Insulin In Type 2 Diabetes Eric L. Johnson, M.D. Associate Professor Department of Family and Community Medicine University of North Dakota School of Medicine and Health Sciences Assistant

INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? MARTHA M. BRINSKO, MSN, ANP-BC CHARLOTTE COMMUNITY HEALTH CLINIC CHARLOTTE, NC Diagnosed and undiagnosed diabetes in the United

Diabetes Fundamentals Prevalence of Diabetes in the U.S. Undiagnosed 10.7% of all people 20+ 23.1% of all people 60+ (12.2 million) Slide provided by Roche Diagnostics Sources: ADA, WHO statistics Prevalence

Resident s Guide to Inpatient Diabetes 1. All patients with diabetes of ANY TYPE, regardless of reason for admission, must have a Hemoglobin A1C documented in the medical record within 24 hours of admission

Calculating Insulin Dose First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This

T Y P E 1 T Y P E 2 INSULIN There are many different insulins for many different situations and lifestyles. This section should help you and your doctor decide which insulin or insulins are best for you.

UW MEDICINE PATIENT EDUCATION Using Insulin Basic facts about insulin and self-injection This handout explains what insulin is, the different types of insulin, how to store it, how to give an injection

Presented By: Dr. Nadira Husein I have no conflict of interest Disclosures I have received honoraria/educational grants from the following: Novo Nordisk, Eli Lilly, sanofi-aventis, Novartis, Astra Zeneca,

Without a working knowledge of the way insulin works in your body it is very difficult to effectively manage diabetes... Kind of like driving a car without knowing how to use the gas pedal and brakes...

Insulin: A Practice Update Department of Nursing Staff Development Elizabeth Borgelt, MS, RN Learning Outcome The learner will be able to identify the different types of insulins available, their actions,

Aim These protocols aim to provide the necessary guidance to enable insulin to be initiated safely and effectively Objectives 1. To provide the suggested procedure for the initiation of insulin for people

of nurse A new insulin order form should be completed for subsequent changes to type of insulin and/or frequency of administration 1. Check times for point of care meter blood glucose testing. Pre-Breakfast

Diagnosis Patient MUST BE educated using carbohydrate counting for prial insulin coverage before hospitalization to be eligible for this order set Nursing Metered Glucose (Single Select Section) Metered

Section Three DIABETES MEDICATION INSULIN This section will tell you: About insulin. How to care and store your insulin. When to take your insulin. Different ways of taking insulin. WHAT IS INSULIN? Insulin

Chapter 8 Insulin: Types and Activit y H. Peter Chase, MD Satish Garg, MD INSULIN Before insulin was discovered in 1921, there was little help for people who had type 1 diabetes. Since then, millions of

Glycaemic Control in Adults with Type 1 Diabetes Aim(s) and objective(s) This document aims to provide guidance on good clinical practice in managing glycaemic control in adult patients with Type 1 Diabetes

Page 1 of 5 PURPOSE To assure that DOP inmates with Diabetes, who require insulin therapy, are receiving high quality Primary Care for their condition. POLICY All DOP Primary Care Providers are to follow

1 When and how to start insulin: strategies for success in type diabetes Treatment of type diabetes in 199: with each step treatment gets more complex Bruce H.R. Wolffenbuttel, MD PhD Professor of Endocrinology

Starting patients on the V-Go Disposable Insulin Delivery Device A simple guide for your practice For adult patients with Type 2 diabetes on basal insulin who need to take the next step Identify appropriate

Strategies for Managing the Patient on Insulin Judy Davis RN, BA, CDE, FAADE May 3, 2013 1 Objectives To identify the need for all health providers to play an active role in the education of the individual

Introduction Diabetes is a chronic disease that affects the body s ability to metabolize food. The body converts much of the food we eat into glucose, the body s main source of energy. Glucose is carried

Diabetes Treatment in a New Era: When to Begin Insulin and How to deliver it. Objectives 1. Briefly review the evolution of insulin therapy. 2. Identify the types of insulin currently available for treatment

Advanced Carbohydrate Counting Living Well with Your Health Conditions What is Carbohydrate Counting? Carbohydrate counting focuses on the amount of carbohydrate (carbs) in your diet. Carbohydrate is the

Insulin What is Insulin? Insulin is a hormone produced by special cells in the pancreas These cells that are produced are called beta cells Insulin allows the glucose from food we eat to enter the cells

Guideline for members of the diabetes team and dietetic department for advising on insulin dose adjustment and teaching the skills of insulin dose adjustment to adults with type 1 or type 2 diabetes mellitus

Type 1 Diabetes Management Based on Glucose Intake www.utmem.edu/endocrinology click Patients (Revised 7/13/2007) The following is a system of insulin therapy, diet management, and blood glucose monitoring

Diabetes Sans Frontières Guideline for Insulin Therapeutic Review in patients with Type 2 Diabetes 1. Introduction This guideline has been developed in order to support practices to undertake insulin therapeutic

INJEX Self Study Program Part 1 What is Diabetes? Diabetes is a disease in which the body does not produce or properly use insulin. Diabetes is a disorder of metabolism -- the way our bodies use digested

Insulin initiation in type 2 diabetes: Experience and insights Joan Everett A diagnosis of type 2 diabetes can be devastating for the individual and their family. Furthermore, many people with diabetes

Diabetes Mellitus 1 Chapter 43. Diabetes Mellitus, Self-Assessment Questions 1. A 46-year-old man presents for his annual physical. He states that he has been going to the bathroom more frequently than

Initiation and Titration of Insulin Analogs in the Patient with Type 2 Diabetes Supported by an educational grant from Novo Nordisk Inc. This program is supported by an educational grant from Novo Nordisk

Page: 1 of 10 PURPOSE To provide a standard procedure for optimizing care of the inpatient with hyperglycemia and/or diabetes. Substantially provide safe and effective glucose control for all adult inpatients.

Managing the Hospitalized Patient on Insulin: Care Transition Catie Prinzing MSN, APRN, CNS Diabetes and Hospitalization People with DM are hospitalized 3x more frequently than patients without diabetes

Managing Insulin Requirements at School by Rodney Lorenz, MD and Janet Silverstein, MD Introduction Multiple advances over the past decade have revolutionized treatment of diabetes in youth. Two fundamental

Workshop A Tara Kadis Considerations/barriers in decision making about insulin verses GLP-1 use in people with type 2 diabetes Which Insulin regimes should we consider? Diabetes is a progressive multi-system

To ensure the functioning of the site, we use cookies. We share information about your activities on the site with our partners and Google partners: social networks and companies engaged in advertising and web analytics. For more information, see the Privacy Policy and Google Privacy &amp Terms.
Your consent to our cookies if you continue to use this website.